So, what’s with those cholesterol numbers?
Like many things in life, too much of a good thing can have consequences.
Cholesterol is one of those instances. While it is innately good because it builds cells, makes vitamins and certain hormones within the body, it can become a problem when it builds up plaque in the arteries. Some of what happens in this process depends on many things, including two lipoproteins that carry your cholesterol through your bloodstream.
About a year and a half ago, my lipid profile numbers/cholesterol test had crept up from the year before and I knew that this could raise my risk of developing coronary artery disease, vascular disease, or stroke.
My primary care physician discussed starting a statin to bring my levels down. I didn’t have any of the diseases that predispose me to heart disease and my family history was clear, so I asked if she could give me six months to try to bring down the level with diet and exercise. She agreed, and so my journey began with eating in a new way that essentially eliminated many of the high fat foods I knew and loved. I am of a generation that grew up eating red meat, butter, ice cream, bacon and eggs on Sunday mornings, drinking whole milk and thoroughly indulging in all kinds of fatty foods.
I did research and began reading labels equipped with new dietary knowledge and a challenge to do better. It took me awhile to lose weight but at the end of a year, I had lost 15 pounds, and while my total cholesterol was still a little above goal, all my other numbers had come back to normal. My LDL (bad cholesterol) had dropped by 27%, which brought it below the near optimal goal of <=130.
I am very happy with my results and have not gained any weight as I continue my low-fat diet.
The good news is that if I needed to be treated, I know that statin medications are safe and very good at lowering levels to within goals.
Statins Are Generally Safe
“Everyone worries about the side effects of a statin and the concerns on the liver and muscles,” said John J. Guerin, MD, FACC, a cardiologist with Cape Cod Healthcare Cardiovascular Center in Falmouth. “While it gets processed through the liver, the chance of having a liver problem is less than 1%. The other concern is a muscle problem called rhabdomyolysis, where the muscle is broken down. The chance of having this happen is less than 1%. They are really safe medications.”
Cardiologists and primary care physicians make decisions to treat with statins by assessing your lipid levels, your medical history, cardiac history, and family history.
First, a short primer on the cholesterol numbers. Low density lipoprotein (LDL) is often referred to as bad cholesterol. High levels cause plaque to build up in your blood vessels and increase your risk of heart disease and stroke.
High density lipoprotein (HDL) is often referred to as good cholesterol. It returns cholesterol to your liver to be moved out of the body. High levels can reduce your risk of heart disease, stroke, and other health problems.
Total cholesterol, triglycerides also come in to play in increasing risk as well.
Treatment depends on whether it’s a primary prevention or secondary prevention, Dr. Guerin said.
“In general, if you have coronary artery disease, you need to be on a statin no matter what your cholesterol numbers are. If you are in primary prevention, then treatment depends on your risk.”
Primary prevention is for someone who has not had a vascular event like a stroke, heart attack, bypass, stenting procedure or peripheral artery disease, he explained. Secondary prevention is for someone who has had bypass surgery, stenting, carotid artery disease, vascular disease, coronary artery disease, or peripheral artery disease. They are treated with a statin regardless of what their cholesterol numbers are and should be on a high dose, he said.
Patients who have had bypass surgery or a stent, automatically go on a high dose of Atorvastin 80 mg. or Crestor 40 mg. regardless of their numbers, according to Dr. Guerin.
The primary group is the larger group and is usually treated by the primary care providers, he said. They most often follow the goals set by the Cholesterol Education Program Adult Treatment Panel III (ATP III) guidelines.
“The guidelines go through the seven steps, such as checking your lipid profile and, depending on if it is primary or secondary, there is optimal, near optimal/borderline and very high,” said Dr. Guerin. “Then we determine what kind of risk the person has. If they have heart disease, carotid artery disease, or peripheral artery disease, that would be secondary prevention requiring treatment with a statin. If they don’t have those, then they would be primary prevention.
“Next, you would look at their risk score such as smoking, hypertension, family history of if you are a male greater than 45 or female greater than 55. All those increase your risk.
“Additionally, the guidelines include the Framingham Risk Score point system that helps decide if your 10-year risk is less than 10-20% or greater than 20% and that factors in when you start treatment.”
